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General NPI Number Information
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NPI Number | 1689261513
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Entity Type | Individual
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Provider Name | MODUPEOLUWA MARIAM ODU-ONIKOSI
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Gender | Female
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Dates
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Enumeration Date | 12/27/2020
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Last Update Date | 03/26/2025
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Provider Practice Location Address
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Address Line | 1401 ROYAL PKWY STE C
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City | EULESS
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State | TX
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Zip | 76040-6725
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Country | US
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Telephone | 214-378-5577
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Fax | 214-983-1110
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Provider Business Mailing Address
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Address Line | 1401 ROYAL PKWY STE C
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City | EULESS
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State | TX
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Zip | 76040-6725
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Country | US
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Telephone | 214-378-5577
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Fax | 214-983-1110
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SP0810X
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Taxonomy Name | Child & Family Psychiatric/Mental Health Clinical Nurse Specialist
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License Number | 1026808
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 880756
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License Number State | TX
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